Programmes for Mother and Child Nutrition

Mother & Child Nutrition

More than half of all child deaths are associated with malnutrition, which weakens the body's resistance to illness. Poor diet, frequent illness, and inadequate or inattentive care of young children can lead to malnutrition.

If a woman is malnourished during pregnancy, or if her child is malnourished during the first two years of life, the child's physical and mental growth and development may be slowed. This cannot be made up when the child is older – it will affect the child for the rest of his or her life.

Children have the right to a caring, protective environment and to nutritious food and basic health care to protect them from illness and promote growth and development.

“ With our resources and the money we spend we could easily accomplish three times what we do, in half the time we normally take, if we were to operate in mission mode with a vision for the nation. ”

-- APJ Abdul Kalam - President of India - Ignited Minds

Malnutrition in India

Malnutrition is more common in India than in Sub-Saharan Africa. One in every three malnourished children in the world lives in India.

About 50 per cent of all childhood deaths are attributed to malnutrition. Malnutrition limits development and the capacity to learn.

In India, around 46 per cent of all children below the age of three are too
small for their age, 47 per cent are underweight and at least 16 per cent are
wasted. Many of these children are severely malnourished.

The prevalence of malnutrition varies across states, with Madhya Pradesh
recording the highest rate (55 per cent) and Kerala among the lowest (27 per
cent).

Malnutrition in children is not affected by food intake alone; it is also
influenced by access to health services, quality of care for the child and
pregnant mother as well as good hygiene practices. Girls are more at risk of
malnutrition than boys because of their lower social status.

Malnutrition in early childhood has serious, long-term consequences because
it impedes motor, sensory, cognitive, social and emotional development.
Malnourished children are less likely to perform well in school and more
likely to grow into malnourished adults, at greater risk of disease and early
death. Around one-third of all adult women are underweight. Inadequate care
of women and girls, especially during pregnancy, results in low-birth weight
babies. Nearly 30 per cent of all newborns have a low birth weight, making
them vulnerable to further malnutrition and disease.

Vitamin and mineral deficiencies also affect children’s survival and
development. Anaemia affects 74 per cent of children under the age of three,
more than 90 per cent of adolescent girls and 50 per cent of women. Iodine
deficiency, which reduces learning capacity by up to 13 per cent, is
widespread because fewer than half of all households use iodised salt.
Vitamin A deficiency, which causes blindness and increases morbidity and
mortality among pre-schoolers, also remains a public-health problem.

Maharashtra, India Objectives

Reduction in Grade 3 & 4 malnutrition in 0-6 age group

Special focus on health, nutrition and immunisation aspects in 0-3 age group

Reduction in Grade 1 & 2 malnutrition in 0-6 age group

Newborn care initiatives

Antenatal, perinatal and postnatal care for mothers

Focus on pre-teen/adolescent girls: nutrition and health education

Transfer of the management function to the community

Focus areas

Antenatal care

Feeding practices

Complete immunisation

Deworming

Micronutrient supplementation

Nutrition/health education

Issues for thought

Still too much focus on food, too little on improving child-care behaviour, family nutrition patterns

Children in 0-3 age group and from disadvantaged groups not served adequately by existing ICDS

Lack of clear policy focus on areas with greatest levels of malnutrition

Interaction between actors concerned with malnutrition, especially the communities to be served

Passion, commitment, orientation to action

Infant and Young Child Feeding and Nutrition

Feeding is a critical aspect of caring for
infants and young children. Appropriate feeding practices stimulate
bonding with the caregiver and psycho-social development. They lead to
improved nutrition and physical growth, reduced susceptibility to common
childhood infections and better resistance to cope with them. Improved
health outcomes in young children have long-lasting health effects
throughout the life-span, including increased
performance and productivity, and reduced risk of certain non-communicable diseases.

Malnutrition contributes to more than half of all childhood deaths, although
it is rarely listed as the direct cause. For most children, lack of access
to food is not the only cause of malnutrition. Poor feeding practices and
infection, or a combination of the two, are both major factors of
malnutrition. Infection – particularly frequent or persistent diarrhoea,
pneumonia, measles and malaria – undermines nutritional status. Poor feeding
practices, such as inadequate breastfeeding, offering the wrong foods,
giving insufficient quantities, and not ensuring that the child gets enough
food, contribute to malnutrition.

Malnourished children are, in turn, more vulnerable to disease and the vicious circle is established.

Adolescence represents a window of opportunity to prepare for a healthy
adult life. During adolescence, nutritional problems originating earlier in
life can potentially be corrected, in addition to addressing current ones.
It is also a timely period to shape and consolidate healthy eating and
lifestyle behaviours, thereby preventing or postponing the onset of
nutrition-related chronic diseases in adulthood.

As adolescents have a low prevalence of infections such as pneumonia and
gastroenteritis compared with younger children, and of chronic disease
compared with ageing people, they have generally been given little health
and nutrition attention, except for reproductive health concerns. However,
there are nutritional issues, which are adolescent-specific, and which call
for specific strategies and approaches.

Programmes for Mother & Child Nutrition

No claim for originality of the programmes is made by HETV. We acknowledge our gratitude to the many people and sources whose work has been drawn freely upon. We thank them all. Programmes will be supplemented and supported by booklets, leaflets, posters and informational guides in Marathi and English, and made freely available at health worker stations, hospitals, schools, and more.

Enough Food and the Right Kind of Food

Chronically Undernourished
40% of both mothers and children in Maharashtra, India are chronically
undernourished, and under-five mortality occurs at 58 deaths per 1000 live
births, or 1 in every 17 children. A very large number of these deaths are
caused by dehydration from diarrhoea, the most easily preventable cause of
childhood mortality.

Nurturing
NewbornsSkilled attendance during pregnancy, childbirth and the immediate
postpartum period. Mothers will be provided with training for breastfeeding
from the nurse or midwife, encouraged about the importance of providing
colostrum within the first half hour after birth, and advised about other
questions they may have about their newborn or postpartum period.

Nutritional Needs of Young Children

Breastfeeding
Protect against diseases through the promotion of clear guidelines about
proper feeding practices and the benefits of immunity. Promote the practice of
providing colostrum to the child within the first half hour after birth,
exclusive breastfeeding during the first six months of a child’s life, with
appropriate complementary feeding from six months and continued breastfeeding
for two years or beyond, with supplementation of vitamin A and other
micronutrients as needed.

Complementary Feeding
Complementary feeding means giving foods in addition to breastmilk.
Malnutrition can result from suboptimal breastfeeding practices, poor
quality complementary foods, detrimental feeding practices, and
contamination of complementary food and feeding utensils. The second half
of an infant's first year is an especially vulnerable time because infants
are learning to eat and must be fed soft foods frequently and patiently.
If nutritional intake is inadequate, the consequences persist throughout
life.

Continuous Feeding
During Diarrhoea
Experience shows that food should not be withheld from infants and children
with acute diarrhoea. Depending on their feeding status, children should
receive breast-milk or diluted milk feeds; in cases of dehydration, these
should be offered as soon as initial rehydration therapy has been completed.
Appropriate locally available foods (cereals) should be offered as soon as
the appetite returns. After the diarrhoea ceases, more than the usual amount
of food should b given for a short period. The routine use of any special
infant formula (lactose-free products) for diarrhoea cases should be strongly
discouraged as they are only rarely necessary and are costly.

Protecting Children From Infections

Measles Immunization
Reduce incidence of diarrhoea by promoting measles vaccination within the
first year of a child’s life. 100% immunization coverage against measles is
the programme goal.

Diarrhoea
Management
Intended to target mothers’ confusion and lack of understanding about how to
recognize, assess the degree of, and treat diarrhoeal dehydration. Mothers
will be taught the crucial need for immediate fluid replacement, increased
fluids and food, how to correctly prepare home-made and packaged ORS,
cereal-based ORS, when and why to use it, and continuous feeding, including
breastfeeding.

Recognizing Dehydration
If mothers could recognize and treat dehydration early
on at home, the great majority of children would not need additional medical
care. While only 41% of mothers in Maharashtra can correctly identify
symptoms suggesting a child needs medical treatment for dehydration, 77% take
a child with diarrhoea to a health facility. In this way, better practice and
education would save mothers the trouble and expense of travelling to the
health centre (and also prevent them from spending money on unnecessary
drugs), and it would release some of the burden on health facilities,
allowing better treatment for children who are severely ill.

The first-level health worker, a community health worker who has a crucial
role to play in disseminating knowledge and skills for the management of
diarrhoea, as regards the use of both home remedies and ORS. ORS packets
should be available in adequate supply at this level and throughout the
entire health system. If this is not possible, maximum efforts should
continue towards this end and, in the meantime, as complete a formulation as
possibly should be used, recognizing its limitations. When potassium is a
missing ingredient, patients should be encouraged to drink fluids that are
rich in potassium (fruit juices).
Increased fluids and Preparation of home-made and packaged solutions. For the preparation of ORS solution the
safest water should be used.

Measuring Sugar, Salt and Water
Correct the confusion created by years of mixed messages regarding
measurement of the ingredients in rehydration solutions. Mothers will receive
a plastic one-litre bottle, with a label about how to recognize signs and
degrees of dehydration, how to prepare home fluids for rehydration, and how
to mix and prepare home-made and packaged ORS. Additionally, they will
receive a 2-sided spoon to correctly measure salt and sugar.

Cereal Based ORT
Oral rehydration therapy, if properly practiced, can cut infant and child
mortality rates by at least half and obviate the need for countless millions
of costly visits to hospitals, health centres, and clinics in all countries.
But is this feasible? Packets of oral rehydration salts (ORS) are not
universally available and the simpler sugar-salt solution can have dangerous
effects if it is improperly mixed or administered. Cereal-based ORT can
overcome both of these disadvantages by providing yet another option for oral
rehydration therapy.

Safe Water, Hygiene and Sanitation Facilities

Safe Water Systems
Safe Water Systems are water quality interventions that employ simple,
inexpensive and robust technologies appropriate for the developing world. The
objective is to make water safe through disinfection and safe storage at the
point of use.

Point-of-use treatment of contaminated water using sodium hypochlorite
solution purchased locally and produced in the community from water and salt
using an electrolytic cell;

Behaviour change techniques, including social marketing, community
mobilization, motivational interviewing, communication, and education, to
increase awareness of the link between contaminated water and disease and the
benefits of safe water, and to influence hygiene behaviours including the
purchase and proper use of the water storage vessel and disinfectant.

Disinfect soiled water with this free and easy
technique using solar radiation. This simple process of filling
transparent containers with water, and exposing them to full sunlight for
about five hours, destroys pathogens in the water.

Treat soiled water and prevent the spread of disease
by promoting the practice of boiling water and the usage of chlorine,
iodine, or even household bleach, to conduct home water disinfection.
Health workers will be trained to use these practices, and will convey
the techniques to mothers.

Toilet Facilities in All Schools
Encourage and contribute to developing the necessary
partnership between the state of Maharashtra and the Government of
India’s programmes to establish toilet facilities in all schools. The
Indian government has launched a focused campaign to increase the
households in the country that have toilets by 2010. Additionally, we
will target the urgent need for separate toilets for boys and girls,
together with a hand-washing facility in every school in Maharashtra.

Promote the habit of Hand Washing with Soap and Water
to decrease episodes of diarrhoea. To ensure the sufficient availability
of soap, partnerships with local manufacturers will be used to promote
this practice.

Quality care when children fall ill

Micronutrient deficiencies

Zinc Supplementation
ORS and Zinc : Treatment of diarrhoea is now more effective
Prevent deaths from diarrhoea and decrease child susceptibility to diarrhoea
after episodes by educating all health-care providers and mothers about zinc
supplementation. Through focused and integrated campaigns, and through
partnerships with local manufacturers, we will increase availability of zinc
supplements.

Health Education

Facts for Life Wall Calendar
This 13-month calendar, corresponding to the 13 Facts for Life messages,
makes life-saving information easily available to everyone. It presents
important health information about an issue or concern that every family has
a right to know. The messages are simple, and people in Maharashtra can act
on them. The calendar will also indicate state health days, and health
educational mass media events.